{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:29:41Z","timestamp":1791235781328,"version":"4.1.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Inspiratory muscle weakness may affect exercise tolerance; however, the relationship between inspiratory muscle strength and the 6-minute walk distance (6MWD) in patients with acute heart failure (AHF) is unknown. This study aimed to quantitatively investigate the association between inspiratory muscle strength at the start of cardiac rehabilitation (CR) and 6MWD at discharge in patients with AHF. This single-center, retrospective, observational study enrolled 275 patients with AHF who underwent CR. Patients unable to walk before admission, with isometric knee extensor strength\/weight (%IKES) &lt;\u20090.3 kgf\/kg at the start of CR, or unable to undergo examination were excluded. Maximum inspiratory mouth pressure (PI-max) was used as an indicator of inspiratory muscle strength and was measured at the start of CR. The measured PI-max was divided by the predicted value and used for analysis (%PI-max). The primary outcome was 6MWD, an indicator of exercise tolerance, and was measured at discharge. Statistical analysis was performed using multiple regression analysis, with 6MWD at discharge as the dependent variable and %PI-max at the start of CR as the independent variable. Covariates were age, New York Heart Association class, physical frailty, and %IKES at the start of CR. The final analysis included 94 patients (median age 83.0 years, 57.5% male). Multiple regression analysis showed that %PI-max at the start of CR was significantly associated with 6MWD at discharge even after adjustment for covariates (\u03b2 =\u2009 0.223, 95% confidence interval: 0.063\u20130.382, p =\u2009 0.007). PI-max was a factor associated with 6MWD at discharge in patients with AHF. In conclusion, increased inspiratory muscle strength may contribute to improved 6MWD in patients with AHF.<\/jats:p>","DOI":"10.1371\/journal.pone.0317679","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T18:48:44Z","timestamp":1739386124000},"page":"e0317679","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Influence of inspiratory muscle strength on 6-minute walk distance in patients with acute heart failure"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0876-1924","authenticated-orcid":true,"given":"Ren","family":"Takahashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9725-6322","authenticated-orcid":true,"given":"Junichi","family":"Yokota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Matsukawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Matsushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeru","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiki","family":"Tsushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"issue":"2","key":"pone.0317679.ref001","doi-asserted-by":"crossref","first-page":"e0118218","DOI":"10.1371\/journal.pone.0118218","article-title":"High prevalence of respiratory muscle weakness in hospitalized acute heart failure elderly patients","volume":"10","author":"P Verissimo","year":"2015","journal-title":"PLoS One"},{"issue":"2","key":"pone.0317679.ref002","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/resp.13432","article-title":"Respiratory muscle weakness increases dead-space ventilation ratio aggravating ventilation-perfusion mismatch during exercise in patients with chronic heart failure","volume":"24","author":"N Hamazaki","year":"2019","journal-title":"Respirology"},{"issue":"2","key":"pone.0317679.ref003","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1159\/000509940","article-title":"Heart failure results in inspiratory muscle dysfunction irrespective of left ventricular ejection fraction","volume":"100","author":"J Spiesshoefer","year":"2021","journal-title":"Respiration"},{"key":"pone.0317679.ref004","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.cardfail.2015.10.010","article-title":"Inspiratory muscle weakness is associated with exercise intolerance in patients with heart failure with preserved ejection fraction: a preliminary study","volume":"22","author":"K Yamada","year":"2016","journal-title":"J Card Fail"},{"issue":"4","key":"pone.0317679.ref005","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/S1078-5337(05)70087-3","article-title":"Mechanisms of hypoxemia","volume":"6","author":"NR Henig","year":"2000","journal-title":"Respir Care Clin N Am"},{"key":"pone.0317679.ref006","doi-asserted-by":"crossref","first-page":"2200144","DOI":"10.1183\/13993003.00144-2022","article-title":"Excess ventilation and exertional dyspnoea in heart failure and pulmonary hypertension","volume":"60","author":"J Neder","year":"2022","journal-title":"Eur Respir J"},{"issue":"Pt 1","key":"pone.0317679.ref007","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1113\/jphysiol.2006.117614","article-title":"The influence of inspiratory muscle work history and specific inspiratory muscle training upon human limb muscle fatigue","volume":"577","author":"AK McConnell","year":"2006","journal-title":"J Physiol"},{"key":"pone.0317679.ref008","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1152\/japplphysiol.00141.2022","article-title":"Inspiratory and leg muscle blood flows during inspiratory muscle metaboreflex activation in heart failure with preserved ejection fraction","volume":"133","author":"S Hammer","year":"2022","journal-title":"J Appl Physiol"},{"key":"pone.0317679.ref009","doi-asserted-by":"crossref","first-page":"1235178","DOI":"10.3389\/fcvm.2023.1235178","article-title":"Inflammation in acute heart failure","volume":"10","author":"M Garofalo","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"pone.0317679.ref010","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/nrcardio.2015.134","article-title":"Pathophysiology and clinical evaluation of acute heart failure","volume":"13","author":"RJ Mentz","year":"2016","journal-title":"Nat Rev Cardiol"},{"issue":"2","key":"pone.0317679.ref011","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s10741-016-9593-0","article-title":"Skeletal muscle inflammation and atrophy in heart failure","volume":"22","author":"KJ Lavine","year":"2017","journal-title":"Heart Fail Rev"},{"issue":"10","key":"pone.0317679.ref012","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1253\/circj.CJ-19-0342","article-title":"JCS 2017\/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure- digest version","volume":"83","author":"H Tsutsui","year":"2019","journal-title":"Circ J"},{"issue":"16","key":"pone.0317679.ref013","first-page":"e240-327","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American college of cardiology foundation\/American heart association task force on practice guidelines","volume":"128","author":"Writing Committee Members","year":"2013","journal-title":"Circulation"},{"issue":"10","key":"pone.0317679.ref014","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1016\/S0735-1097(03)00309-7","article-title":"Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure","volume":"41","author":"A Nohria","year":"2003","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"pone.0317679.ref015","first-page":"S129\u201339","article-title":"Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes","volume":"36","author":"A Mebazaa","year":"2008","journal-title":"Crit Care Med"},{"issue":"4","key":"pone.0317679.ref016","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0272-5231(05)70059-9","article-title":"Respiratory muscle testing","volume":"22","author":"LE Flaminiano","year":"2001","journal-title":"Clin Chest Med"},{"issue":"4","key":"pone.0317679.ref017","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1164\/rccm.166.4.518","article-title":"ATS\/ERS statement on respiratory muscle testing","volume":"166","author":"American Thoracic Society\/European Respiratory Society","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"issue":"12","key":"pone.0317679.ref018","first-page":"1305","article-title":"Age-related changes in static maximal inspiratory and expiratory pressures","volume":"35","author":"M Suzuki","year":"1997","journal-title":"Nihon Kyobu Shikkan Gakkai Zasshi"},{"issue":"1","key":"pone.0317679.ref019","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1253\/circj.CJ-22-0234","article-title":"JCS\/JACR 2021 guideline on rehabilitation in patients with cardiovascular disease","volume":"87","author":"S Makita","year":"2022","journal-title":"Circ J"},{"issue":"1","key":"pone.0317679.ref020","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1164\/ajrccm.166.1.at1102","article-title":"ATS statement: guidelines for the six-minute walk test","volume":"166","author":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0317679.ref021","first-page":"61","article-title":"Functional evaluation: the barthel index","volume":"14","author":"FI Mahoney","year":"1965","journal-title":"Md State Med J"},{"issue":"10","key":"pone.0317679.ref022","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"M Herdman","year":"2011","journal-title":"Qual Life Res"},{"issue":"5","key":"pone.0317679.ref023","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.jval.2016.03.1834","article-title":"Comparison of value set based on DCE and\/or TTO data: scoring for EQ-5D-5L health states in Japan","volume":"19","author":"T Shiroiwa","year":"2016","journal-title":"Value Health"},{"key":"pone.0317679.ref024","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/S0003-9993(97)90005-8","article-title":"Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years","volume":"78","author":"RW Bohannon","year":"1997","journal-title":"Arch Phys Med Rehabil"},{"key":"pone.0317679.ref025","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1111\/ggi.14005","article-title":"The revised Japanese version of the cardiovascular health study criteria (revised J-CHS criteria)","volume":"20","author":"S Satake","year":"2020","journal-title":"Geriatrics Gerontol Int"},{"issue":"3","key":"pone.0317679.ref026","first-page":"189","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"MF Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"issue":"1","key":"pone.0317679.ref027","first-page":"38","article-title":"CONUT: a tool for controlling nutritional status. First validation in a hospital population","volume":"20","author":"J Ignacio de Ul\u00edbarri","year":"2005","journal-title":"Nutr Hosp"},{"issue":"4","key":"pone.0317679.ref028","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses","volume":"41","author":"F Faul","year":"2009","journal-title":"Behav Res Methods"},{"key":"pone.0317679.ref029","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988"},{"issue":"3","key":"pone.0317679.ref030","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.tjem.2018.08.001","article-title":"User\u2019s guide to correlation coefficients","volume":"18","author":"H Akoglu","year":"2018","journal-title":"Turk J Emerg Med"},{"key":"pone.0317679.ref031","volume-title":"Primer of applied regression and analysis of variance","author":"SA Glantz","year":"2001"},{"key":"pone.0317679.ref032","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.ijcard.2017.02.109","article-title":"Reliability, construct validity and determinants of 6-minute walk test performance in patients with chronic heart failure","volume":"240","author":"NHMK Uszko-Lencer","year":"2017","journal-title":"Int J Cardiol"},{"issue":"4","key":"pone.0317679.ref033","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1067\/mhj.2001.118468","article-title":"Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure","volume":"142","author":"RESOLVD Pilot Study Investigators","year":"2001","journal-title":"Am Heart J"},{"issue":"5","key":"pone.0317679.ref034","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/j.1751-7133.2010.00151.x","article-title":"The 6-minute walk is associated with frailty and predicts mortality in older adults with heart failure","volume":"16","author":"R Boxer","year":"2010","journal-title":"Congest Heart Fail"},{"key":"pone.0317679.ref035","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1054\/jcaf.2000.8830","article-title":"Functional capacity in patients with congestive heart failure","volume":"6","author":"M Hendrican","year":"2000","journal-title":"J Card Fail"},{"issue":"11","key":"pone.0317679.ref036","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1590\/1414-431X20143896","article-title":"Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: potential role of a respiratory muscle metaboreflex","volume":"47","author":"AM Moreno","year":"2014","journal-title":"Braz J Med Biol Res"},{"issue":"Pt 1","key":"pone.0317679.ref037","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1469-7793.2001.0002k.x","article-title":"Robin Hood for the lungs? A respiratory metaboreflex that \u201csteals\u201d blood flow from locomotor muscles","volume":"537","author":"DR Seals","year":"2001","journal-title":"J Physiol"},{"issue":"1","key":"pone.0317679.ref038","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/JES.0b013e31823b5f13","article-title":"Skeletal muscle power: a critical determinant of physical functioning in older adults","volume":"40","author":"KF Reid","year":"2012","journal-title":"Exerc Sport Sci Rev"},{"issue":"5","key":"pone.0317679.ref039","doi-asserted-by":"crossref","first-page":"M453\u201360","DOI":"10.1093\/gerona\/58.5.M453","article-title":"Old adults perform activities of daily living near their maximal capabilities","volume":"58","author":"T Hortob\u00e1gyi","year":"2003","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0317679.ref040","doi-asserted-by":"crossref","first-page":"101266","DOI":"10.1016\/j.arr.2021.101266","article-title":"The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: a systematic review and meta-analysis","volume":"67","author":"KA Ramsey","year":"2021","journal-title":"Ageing Res Rev"},{"issue":"2","key":"pone.0317679.ref041","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s40520-016-0558-x","article-title":"Comparison of the measurement properties of the Functional Independence and difficulty scale with the barthel index in community-dwelling elderly people in Japan","volume":"29","author":"T Saito","year":"2017","journal-title":"Aging Clin Exp Res"},{"issue":"3","key":"pone.0317679.ref042","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s11136-015-1108-2","article-title":"Japanese population norms for preference-based measures: EQ-5D-3L, EQ-5D-5L, and SF-6D","volume":"25","author":"T Shiroiwa","year":"2016","journal-title":"Qual Life Res"},{"issue":"4","key":"pone.0317679.ref043","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s13539-013-0109-7","article-title":"Relation of respiratory muscle strength, cachexia and survival in severe chronic heart failure","volume":"4","author":"D Habedank","year":"2013","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"6","key":"pone.0317679.ref044","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s40520-016-0534-5","article-title":"Respiratory muscle strength in relation to sarcopenia in elderly cardiac patients","volume":"28","author":"KP Izawa","year":"2016","journal-title":"Aging Clin Exp Res"},{"key":"pone.0317679.ref045","doi-asserted-by":"crossref","first-page":"131131","DOI":"10.1016\/j.ijcard.2023.131131","article-title":"Cachexia, sarcopenia and heart failure: a last mile to be walked","volume":"388","author":"V Castiglione","year":"2023","journal-title":"Int J Cardiol"},{"key":"pone.0317679.ref046","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ijcard.2023.03.035","article-title":"Prevalence and prognostic impact of the coexistence of cachexia and sarcopenia in older patients with heart failure","volume":"381","author":"Y Fujimoto","year":"2023","journal-title":"Int J Cardiol"},{"issue":"25","key":"pone.0317679.ref047","doi-asserted-by":"crossref","first-page":"3042","DOI":"10.1016\/j.jacc.2017.04.042","article-title":"Time-to-furosemide treatment and mortality in patients hospitalized with acute heart failure","volume":"69","author":"Y Matsue","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"pone.0317679.ref048","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3390\/jcm6090084","article-title":"Feasibility of serial 6-min walk tests in patients with acute heart failure","volume":"6","author":"SP Collins","year":"2017","journal-title":"J Clin Med"},{"issue":"25","key":"pone.0317679.ref049","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1016\/j.jacc.2012.08.1010","article-title":"6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure","volume":"60","author":"DE Forman","year":"2012","journal-title":"J Am Coll Cardiol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317679","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T18:48:57Z","timestamp":1739386137000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317679"}},"subtitle":[],"editor":[{"given":"Vincenzo","family":"Lionetti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,2,12]]},"references-count":49,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0317679","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,12]]}}}